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To attract Registered Nurses (RNs), Registered Practical Nurses (RPNs), and Nurse Practitioners (NPs) to work in the hospitals, long-term care (LTC) homes, home and community care (HCC) agencies, Primary Care, and Mental Health and Addictions agencies in greatest need across Ontario, the Community Commitment Program for Nurses (CCPN) provides a $25,000 incentive to eligible nurses in exchange for a two-year commitment to an eligible employer.

In addition, participating hospitals, LTC homes, HCC agencies, Primary Care, and Mental Health and Addictions agencies who employ eligible nurses through the CCPN may be eligible for an education grant to fund professional development and training opportunities for nurses on their staff.

All participating employers must be a publicly funded Hospital, Long-Term Care home, Home and Community Care agency, Primary Care or Mental Health and Addictions care provider in Ontario.

Visit www.healthforceontario.ca/ccpn for more information.

All employers must submit this Employer Application Form to participate, even if they were approved in a previous cohort of the CCPN.

Send an email to info-hfo@ontariohealth.ca if you have questions prior to completing this application form.

Questions marked with * are required.

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* 1. Organization Name

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* 2. Organization Type

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* 3. Organization Mailing Address

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* 4. Site Address(es) - Please include full addresses for all sites where a Nurse may be hired to work:

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* 5. Email Address for the Primary Contact for this Application

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* 6. Primary Contact for this Application:

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* 7. Additional Contacts - Please provide the full name, title, email and phone number for at least one additional contact related to this application:

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If you are submitting one application for multiple sites, please provide a breakdown for the following questions (#8-#10) for each site. Download and complete THIS TEMPLATE and send via email to info-hfo@ontariohealth.ca after submitting this form.

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* 8. How many Nurses does your organization hope to recruit through the Community Commitment Program for Nurses?

Note: Employers must offer a full-time position or full-time hours to be eligible.

Employment and Vacancy Data

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* 9. How many Nurses does your organization currently employ?

**Note: if any of the values below should be 200 or more, please enter the details in the Comments.

  Full-Time Part-Time Casual Other
RN Permanent
RN Temporary
RPN Permanent
RPN Temporary
NP Permanent
NP Temporary

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* 10. How many Nurse vacancies do you currently have at your organization?

**Note: if any of the values below should be 200 or more, please enter the details in the Comments.

  Full-Time Part-Time Casual Other
RN Permanent
RN Temporary
RPN Permanent
RPN Temporary
NP Permanent
NP Temporary
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* 11. Please confirm each of the following statements by selecting an answer from the drop-down menu for each one:

  Attestation
Your organization is a publicly-funded Hospital, Long-Term Care home, Home and Community Care agency, Primary Care, or Mental Health and Addictions organization;
The Community Commitment Program for Nurses funding will not disrupt any existing employee incentives in place within your organization;
The positions your organization is seeking to fill through the CCPN have been posted internally to existing staff and no suitable candidates were found through that process;
Your organization has in place a suitable Human Resources (HR) infrastructure with sufficient capacity to onboard and support newly hired Nurses;
Any Nurse recruited through the Community Commitment Program for Nurses will be offered a full-time position or full-time hours;
Your organization has secured the necessary finances to support the ongoing employment for the number of Nurses identified in this application; and
Your organization will not receive funds from the Ministry of Health through the Nursing Graduate Guarantee for the purpose of paying a salary to any individual nurse hired through the Community Commitment Program for Nurses.
By submitting this application, you are confirming that the above statements are true.
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